Journal of Urology最新文献

{"title":"A Contemporary Estimate of Vasectomy Failure in the United States: Analysis of US Claims Data.","authors":"Albert Ha, Chiyuan Amy Zhang, Shufeng Li, Ashkan Pourabhari Langroudi, Satvir Basran, Michael Scott, Frank Glover, Francesco Del Giudice, Michael L Eisenberg","doi":"10.1097/JU.0000000000004405","DOIUrl":"10.1097/JU.0000000000004405","url":null,"abstract":"<p><strong>Purpose: </strong>We characterize trends in vasectomy utilization, delivery, and failure in a large administrative database.</p><p><strong>Materials and methods: </strong>We used the Merative MarketScan (2007-2021) Commercial Database to identify vasectomized men. Vasectomy failure (VF) was defined as documented pregnancy ≥ 6 months post procedure. Additional outcomes include the need for repeat vasectomy within 1 year and birth rates. Logistic and Cox proportional hazard regression were used to analyze factors associated with failure.</p><p><strong>Results: </strong>In a cohort of 489,277 vasectomized men, the mean (SD) age was 38 (6) years, with most of the procedures performed by urologists (n = 344,319). Overall postvasectomy pregnancy rate 6 months post procedure was 1.97 cases per 1000 persons per year, representing a pregnancy rate of 0.58%. Annual declines-particularly in recent years-in postvasectomy pregnancy (p_trend = 0.03) and birth (p_trend = 0.04) rates were observed. Older age and recent vasectomy years were associated with reduced odds of VF, while the absence of a postvasectomy semen analysis was associated with increased VF (adjusted odds ratio [aOR]: 1.14; 95% CI: 1.03-1.25; <i>P</i> < .001). Importantly, vasectomies performed by nonurologists (aOR: 1.56; 95% CI: 1.40-1.74; <i>P</i> < .0001) and vasectomies occurring in office-based settings (aOR: 1.25; 95% CI: 1.08-1.44; <i>P</i> < .01) were associated with higher odds of repeat procedures.</p><p><strong>Conclusions: </strong>VF is a rare phenomenon. Older age and vasectomies performed in later years correlate with decreased odds of failure, whereas the lack of postvasectomy semen analysis increases odds of failure. A higher pregnancy rate shortly after the procedure underscores the need to improve patient counseling.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"638-647"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Institutional Analysis of Surgery for Lichen Sclerosus-Induced Penile Urethral Stricture: Establishing Single-Stage Urethroplasty as a Primary Treatment Option.","authors":"Ross Hengel, Alex Vanni, Brad Erickson, Sean Elliott, Ben Breyer, Jill C Buckley, Josh Broghammer, Bryan Voelzke, Jeremy Myers, Keith Rourke","doi":"10.1097/JU.0000000000004434","DOIUrl":"10.1097/JU.0000000000004434","url":null,"abstract":"<p><strong>Purpose: </strong>Ideal treatment of lichen sclerosus (LS)-induced penile urethral strictures (PUS) remains elusive. The objective of this study was to compare multi-institutional outcomes of single-stage urethroplasty (SSU) with oral mucosal graft, staged urethroplasty, and perineal urethrostomy (PU) for treatment of LS-induced PUS.</p><p><strong>Materials and methods: </strong>Multi-institutional analysis was performed at 9 centers on men undergoing SSU, staged urethroplasty, or PU for LS-induced PUS. Meatal strictures (<2 cm), bulbar urethral involvement, and panurethral strictures (>10 cm) were excluded. The primary outcome was recurrence-free status on follow-up assessment. Secondary outcomes included 90-day complications (Clavien ≥2), erectile dysfunction, chordee, and urethrocutaneous fistula.</p><p><strong>Results: </strong>Two hundred thirty-one patients were included with a median stricture length of 5 cm and median follow-up of 53 months among those without stricture recurrence. One-, 5-, and 10-year stricture-free estimates were 90%, 80%, and 75%, respectively. Fifty-five percent (127/231) underwent SSU with oral mucosal graft, 19% (44) staged urethroplasty, and 26% (60) PU. On log-rank, there was no identifiable difference in stricture recurrence between techniques (<i>P</i> = .6) with 5-year stricture-free estimates of 82%, 76%, and 75%, respectively. On χ², there was no significant difference in 90-day complications (7.1% vs 16% vs 8.3%; <i>P</i> = .2), erectile dysfunction (7.1% vs 4.5% vs 3.3%; <i>P</i> = .6), chordee (5.5% vs 6.8% vs 1.7%; <i>P</i> = .4), or urethrocutaneous fistula (2.4% vs 6.8% vs 0%; <i>P</i> = .09). On Cox regression, only obesity (BMI ≥35) was associated with stricture recurrence (HR, 2.31, 95% CI, 1.28-4.17; <i>P</i> = .006).</p><p><strong>Conclusions: </strong>Favorable comparative outcomes confirm SSU as a highly feasible treatment for LS-induced PUS in properly selected patients, especially when considering fewer surgeries required and preservation of an orthotopic meatus.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"628-637"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Clinician-Reported Management Recommendations in Response to Universal Germline Genetic Testing in Patients With Prostate Cancer.","authors":"Neal Shore","doi":"10.1097/JU.0000000000004439","DOIUrl":"10.1097/JU.0000000000004439","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"649-650"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply by Authors.","authors":"I Rivero Belenchón, C B Congregado Ruíz, G Gómez Ciriza, V Gómez Dos Santos, F J Burgos Revilla, R A Medina López","doi":"10.1097/JU.0000000000004469","DOIUrl":"10.1097/JU.0000000000004469","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"579"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Stockholm3, Serum Biomarkers, and Risk Calculators to Predict Prostate Cancer in a Racially and Ethnically Diverse Cohort: Evaluation of the Stockholm3 Multiethnic SEPTA Trial.","authors":"Alon Lazarovich, Hari Vigneswaran, Thorgerdur Palsdottir, Martin Eklund, Andrea Discacciati, Tobias Nordström, Rebecca A Hubbard, Nathan Perlis, Michael R Abern, Daniel M Moreira, Paul Yonover, Alexander K Chow, Kara Watts, Michael A Liss, Gregory R Thoreson, Andre L Abreu, Geoffrey A Sonn, Anna Plym, Fredrik Wiklund, Henrik Grönberg, Adam B Murphy, Scott Eggener","doi":"10.1097/JU.0000000000004437","DOIUrl":"https://doi.org/10.1097/JU.0000000000004437","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to compare performance of Stockholm3 in an external validation with commonly used prostate cancer biomarkers and risk calculators.</p><p><strong>Materials and methods: </strong>SEPTA was a multicenter trial validating Stockholm3 in a racially/ethnically diverse population of men meeting local care guidelines for prostate biopsy (2019-2023). In total, 2115 (98%) men with complete data for risk calculators and biomarkers were included. The primary outcome was detection of Grade Group ≥ 2 (GG ≥ 2) cancer. Predictors included Stockholm3, free/total PSA ratio, PSA density, European Randomized Study of Screening for Prostate Cancer-4, Prostate Biopsy Collaborative Group, and Prostate Cancer Prevention Trial version 2 risk calculators. Performance characteristics were computed at clinically used thresholds for each risk score. ROC analysis, graphical calibration assessment, and decision curve analysis were performed.</p><p><strong>Results: </strong>Among 2115 men, median age was 63 years (IQR: 58-68), median PSA was 6.1 ng/mL (IQR: 4.5-9.0), 415 (20%) had a prior negative prostate biopsy, and 356 (17%) had an MRI performed before biopsy. There were 1200 (56.7%) benign biopsies performed, 307 (14.5%) GG1 cancers detected, and 608 (28.8%) GG ≥ 2 cancers detected. The Stockholm3 test had superior discrimination (all <i>P</i> < .001) compared with all evaluated biomarkers and risk calculators with an AUC of 0.82 vs 0.72 for free/total PSA, 0.76 for PSA density, 0.77 for European Randomized Study of Screening for Prostate Cancer-4, 0.74 for Prostate Biopsy Collaborative Group, and 0.78 for Prostate Cancer Prevention Trial version 2. Decision curve analysis demonstrated superior performance of Stockholm3, showing the highest positive net benefit. Compared with free/total PSA, Stockholm3 could reduce unnecessary biopsies by 44% while maintaining a 0.95 sensitivity.</p><p><strong>Conclusions: </strong>Stockholm3 outperforms other commonly used biomarkers and risk calculators for detecting GG ≥ 2 cancer in a diverse population.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":"213 5","pages":"590-599"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stimulated Raman Histology and Artificial Intelligence Provide Near Real-Time Interpretation of Radical Prostatectomy Surgical Margins.","authors":"Miles P Mannas, Fang-Ming Deng, Adrian Ion-Margineanu, Christian Freudiger, Lea Lough, William Huang, James Wysock, Richard Huang, Steve Pastore, Derek Jones, Deepthi Hoskoppal, Jonathan Melamed, Daniel A Orringer, Samir S Taneja","doi":"10.1097/JU.0000000000004393","DOIUrl":"10.1097/JU.0000000000004393","url":null,"abstract":"<p><strong>Purpose: </strong>Balancing surgical margins and functional outcomes is crucial during radical prostatectomy for prostate cancer. Stimulated Raman histology (SRH) is a novel, real-time imaging technique that provides histologic images of fresh, unprocessed, and unstained tissue within minutes, which can be interpreted by either humans or artificial intelligence.</p><p><strong>Materials and methods: </strong>Twenty-two participants underwent robotic-assisted laparoscopic radical prostatectomy (RALP) with intraoperative SRH surgical bed assessment. Surgeons resected and imaged surgical bed tissue using SRH and adjusted treatment accordingly. An SRH convolutional neural network was developed and tested on 10 consecutive participants. The accuracy, sensitivity, and specificity of the surgical team's interpretation were compared with final histopathologic assessment.</p><p><strong>Results: </strong>A total of 121 SRH periprostatic surgical bed tissue (PSBT) assessments were conducted, an average of 5.5 per participant. The accuracy of the surgical team's SRH interpretation of resected PSBT samples was 98%, with 83% sensitivity and 99% specificity. Intraoperative SRH assessment identified 43% of participants with a pathologic positive surgical margin intraoperatively. PSBT assessment using the convolutional neural network demonstrated no overlap in tumor probability prediction between benign and tumor infiltrated samples, with mean 0.30% (IQR, 0.10%-0.43%) and 26% (IQR, 18%-34%, <i>P</i> < .005), respectively.</p><p><strong>Conclusions: </strong>SRH demonstrates potential as a valuable tool for real-time intraoperative assessment of surgical margins during RALP. This technique may improve nerve-sparing surgery and facilitate decision-making for further resection, reducing the risk of positive surgical margins and minimizing the risk of recurrence. Further studies with larger cohorts and longer follow-up periods are warranted to confirm the benefits of SRH in RALP.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"609-616"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Validation of MyProstateScore 2.0 Testing Using First-Catch, Non-Digital Rectal Examination Urine.","authors":"Jeffrey J Tosoian, Yuping Zhang, Jacob I Meyers, Spencer Heaton, Javed Siddiqui, Lanbo Xiao, Keavash D Assani, Daniel A Barocas, Ashley E Ross, Zoey Chopra, Grace C Herron, Jacob A Edelson, Nathan J Graham, Udit Singhal, Simpa S Salami, Todd M Morgan, Ganesh S Palapattu, John T Wei, Arul M Chinnaiyan","doi":"10.1097/JU.0000000000004421","DOIUrl":"10.1097/JU.0000000000004421","url":null,"abstract":"<p><strong>Purpose: </strong>The 18-gene MyProstateScore 2.0 (MPS2) test was previously validated for detection of grade group (GG) ≥ 2 prostate cancer using post-digital rectal examination (DRE) urine. To improve ease of testing, we validated MPS2 using first-catch, non-DRE urine.</p><p><strong>Materials and methods: </strong>Patients provided first-catch urine before biopsy. MPS2 values were calculated using previously validated models differing only by extent of clinical data included biomarkers alone (BA; no clinical data), biomarkers and clinical factors (BA + CF), and biomarkers, clinical factors, and prostate volume (BA + CF + PV). The primary outcome was GG ≥ 2 cancer on biopsy. MPS2 performance and clinical consequences of testing were compared with PSA and the Prostate Cancer Prevention Trial risk calculator (PCPTrc).</p><p><strong>Results: </strong>The cohort included 266 men with median PSA 6.6 ng/mL (IQR, 4.9-9.1) of whom 103 (39%) had GG ≥ 2 cancer on biopsy. The AUC for GG ≥ 2 cancer was 57% for PSA, 62% for PCPTrc, and 71%, 74%, and 77% for MPS2 models. Under a testing approach detecting > 90% of GG ≥ 2 cancers, MPS2 testing would have avoided 36% to 42% of unnecessary biopsies, as compared with 13% using the PCPTrc. In patients with a prior negative biopsy, MPS2 testing would have avoided 44% to 53% of repeat biopsies, as compared with only 2.6% using PCPTrc.</p><p><strong>Conclusions: </strong>Using first-catch urine, MPS2 meaningfully improved the proportion of biopsies avoided relative to PCPTrc while maintaining highly sensitive detection of GG ≥ 2 cancer. Non-DRE testing provides a convenient, objective, and highly accurate testing option to reduce the need for imaging and biopsy in men with elevated PSA.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"581-589"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment.","authors":"Pranav Sharma","doi":"10.1097/JU.0000000000004441","DOIUrl":"10.1097/JU.0000000000004441","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"578"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply by Authors.","authors":"I Rivero Belenchón, C B Congregado Ruíz, G Gómez Ciriza, V Gómez Dos Santos, F J Burgos Revilla, R A Medina López","doi":"10.1097/JU.0000000000004462","DOIUrl":"10.1097/JU.0000000000004462","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"579-580"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of a Clinical Decision Support Tool to Promote Guideline-Concordant Evaluations in Patients With High-Risk Microscopic Hematuria: A Cluster Randomized Quality Improvement Project.","authors":"Richard S Matulewicz, Sarah Tsuruo, William C King, Arielle R Nagler, Zachary S Feuer, Adam Szerencsy, Danil V Makarov, Christina Wong, Isaac Dapkins, Leora I Horwitz, Saul Blecker","doi":"10.1097/JU.0000000000004436","DOIUrl":"10.1097/JU.0000000000004436","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to determine whether implementation of a clinical decision support (CDS) tool integrated into the electronic health record of a multisite academic medical center increased the proportion of patients with AUA \"high-risk\" microscopic hematuria (MH) who receive guideline-concordant evaluations.</p><p><strong>Materials and methods: </strong>We conducted a 2-arm cluster randomized quality improvement project in which 202 ambulatory sites from a large health system were randomized to either have their physicians receive at time of test results an automated CDS alert for patients with high-risk MH with associated recommendations for imaging and cystoscopy (intervention) or usual care (control). Primary outcome was met if a patient underwent both imaging and cystoscopy within 180 days from MH result. Secondary outcomes assessed individual completion of imaging, cystoscopy, or placement of imaging orders.</p><p><strong>Results: </strong>There were 917 patients randomized to intervention (n = 476) or control (n = 441) arms between October and December 2021. The percentage of eligible patients for whom the alert correctly triggered in the intervention arm was 83%. Primary outcome was achieved in 0.6% vs 0.9% (relative risk 0.69; 95% CI 0.15, 3.10) of patients in the intervention and control arms, respectively. Patients in the intervention and control groups had similar rates of completed imaging (17.7% vs 14.7%) and cystoscopy (1.5% vs 0.9%). Those in the intervention arm had a higher likelihood of CT urogram order (5.5% vs 1.1%, <i>P</i> = .003) and a nonsignificant increase in urology evaluation (11.1% vs 7.5%, <i>P</i> = .09).</p><p><strong>Conclusions: </strong>Implementing an electronic health record-integrated CDS tool to promote evaluation of patients with high-risk MH did not lead to improvements in patient completion of a full guideline-concordant evaluation. The development of an algorithm to trigger a CDS alert was demonstrated to be feasible and effective. Further multilevel assessment of barriers to evaluation is necessary to continue to improve the approach to evaluating high-risk patients with MH.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"558-567"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}